Leukomyelopathy in ataxic calves

Seventy-three fattening calves ranging from 6 to 15 months old on a farm were affected by ataxia over a period of four months. About 10 ataxic animals recovered after the administration of various kinds of vitamins and needle puncture therapy. The principal lesions in 14 ataxic animals examined were characterized by bilateral vacuolation with axonal degeneration confined to the spinal white matter. Ultrastructurally, the vacuoles were present in the periaxonal areas and bounded by dissociated myelin lamellae. No pathogen was isolated from the visceral organs of the animals. The serum copper remained within the normal range. Possible etiological factors remain unknown in the ataxic disease.

Phasic right coronary blood flow in a patient with right ventricular hypertension using transesophageal Doppler echocardiography

Although phasic right coronary artery blood flow in right ventricular hypertension has been studied in animals, reports on human subjects are not available. We observed right coronary artery blood flow before and after operation in a patient with right ventricular hypertension secondary to atrial septal defect using transesophageal Doppler echocardiography. Prior to surgery, blood flow was predominantly diastolic in both right and left coronary arteries. Reversal of right ventricular hypertension after surgery resulted in a change in the pattern of right coronary flow, with doubling of flow during systole.

[Stent placement without thrombolysis in chronic iliac arterial occlusion: preliminary clinical evaluation]

Intra-arterial stent placement without thrombolytic therapy was performed in four patients with chronic iliac arterial occlusion. The length of angiographically observed occluded lesions ranged from 2.0 cm to 14.0 cm (mean: 5.1 cm). The implanted stents included four Wall stents, two Strecker stents and one Palmaz stent. The mean ankle-arm index before and after stenting improved from 0.48 to 0.77, while the mean pressure gradient improved from 82.5 mmHg to 3.0 mmHg. Symptoms were eliminated in all patients after the procedure. No major complications were encountered during the procedure. Primary stent implantation in chronic iliac occlusions is useful to avoid bypass surgery.

[Three interesting pediatric cases with penicillin-resistant Streptococcus pneumoniae infection]

Since penicillin-resistant Streptococcus pneumoniae first recognized in 1967, the rate of penicillin-resistant strains has been increasing worldwide. There have been up to 50% from pediatric specimens in Japan. We reported three pediatric cases with penicillin G resistant Streptococcus pneumoniae infection to show some important clue from these cases for clinical practice against resistant pneumococcal infection. The first case was a typical acute mastoiditis, although we have experienced only masked mastoiditis recently. The second case was meningitis with septicemia, which did not show any abnormality in the first obtained cerebrospinal fluid. The third case was recurrent bronchitis in a child with cerebral palsy. The minimum inhibition concentrations of these isolated strains were 0.25 microgram/ml in the second case an 2.0 microgram/ml in the first and third cases.

Transcatheter hepatic subsegmental arterial chemoembolization therapy using iodized oil for small hepatocellular carcinomas. Correlation between lipiodol accumulation pattern and local recurrence

Lipiodol accumulation patterns were correlated with local recurrences after subsegmental or conventional arterial chemoembolization therapy using iodized oil (Lipiodol-TAE). Thirty-six patients with solitary small hepatocellular carcinomas (HCCs) less than 3 cm in diameter were included in this retrospective study. Superselective subsegmental catheterization was performed in 14 patients (subsegmental Lipiodol-TAE). In the remaining 22 cases, embolization was performed from the proximal portion of the hepatic artery (conventional Lipiodol-TAE). Patterns of Lipiodol accumulations within the tumors were classified in 2 groups: complete and incomplete accumulation. Complete accumulation was observed in 71% of subsegmental Lipiodol-TAE and in 32% of conventional Lipiodol-TAE. The rate of local recurrences within 12 months was significantly higher (p < 0.01) in incomplete accumulation (100%) than in complete accumulation (13%). We suggest that when small HCCs are to be treated with TAE, subsegmental Lipiodol-TAE should be performed because of its superior capability for achieving complete Lipiodol accumulation.

Effect of iohexol on pulmonary arterial pressure at pulmonary angiography in patients with pulmonary hypertension

The effects of 300 mgI/ml of iohexol on pulmonary arterial pressure at selective pulmonary angiography were evaluated in seven patients with pulmonary hypertension due to pulmonary thromboembolism. The total number of contrast injections was 26. Pulmonary arterial pressure was recorded before and after each injection. The effect of iohexol on pulmonary arterial pressure in the pulmonary hypertensive circulation was slight. The results suggest that iohexol at 300 mgI/ml may be safe as a contrast medium for selective pulmonary angiography in patients with pulmonary hypertension.

Structure-activity relationships of diamines, dicarboxamides, and disulfonamides on vinblastine accumulation in P388/ADR cells

Diamines, dicarboxamides, and disulfonamides that have terminal benzene, methyl- or chloro-substituted benzene rings were synthesized and evaluated for the activity of [3H]vinblastine accumulation in multidrug-resistant P388/ADR cells. The efficacy of these compounds was generally in the order of dicarboxamides < diamines < disulfonamides. N-Methylated diamine and disulfonamide compounds having terminal methyl- or chloro-substituted benzene rings in their structure also showed rather potent efficacy. From these findings, we synthesized a novel disulfonamide compound, 1,2,3,4,5,6-hexahydro-2,5-bis(p-toluenesulfonyl)benzo[2,5]diazocine++ + (22). Compound 22 suppressed the efflux of vinblastine from P388/ADR cells and increased its intracellular accumulation, while it barely increased the vinblastine accumulation in sensitive cells (P388/S). Compound 22 significantly potentiated the growth-inhibitory effects of vinblastine, vincristine, colchicine and Adriamycin against P388/ADR cells in vitro.

Recurrent trismus: twenty-year follow-up result

The authors encountered an unusual case of recurrent trismus in a patient who had oral synechia, cleft lip and palate, digital anomalies, and external genital anomaly. Mandibular movement was severely restricted by congenital soft-tissue adhesion in the retromolar region. Despite aggressive surgical efforts and postoperative manipulations, limitation of mouth opening recurred soon after each operation. Furthermore, congenital and postoperative soft-tissue adhesion resulted in severe subsequent jaw deformities, which needed combined maxillary and mandibular advancement.

[Changes in renal function immediately after the angiography]

The effect of radiographic contrast media upon renal function was investigated in 30 patients with normal renal function using Ioxaglate 320 mgI/ml (0.58 Osm/KgH2O), Iohexol 350 mgI/ml (0.88 Osm/kgH2O) and Iomeprol 400 mgI/ml (0.75 Osm/kgH2O). Before and immediately after conventional abdominal angiography, serum and urinary BUN, creatinine, sodium, osmolality and urinary volume were examined. Urinary minute volume increased remarkably immediately after angiography in all the contrast media groups. In Iohexol 350 and Iomeprol 400, creatinine clearance (Ccr) increased immediately after angiography, while no Ccr increase was observed in Ioxaglate 320. FENa increased immediately after angiography in all the contrast media groups. There were no statistical differences in the changes of FENa among Ioxaglate 320, Iohexol 350 and Iomeprol 400. There was no significant change in CH2O. It becomes evident that the osmotic diuresis and its effect on the proximal tubular function are induced by administrated low osmolar contrast media and that these changes are reversible.

Phasic venous return abnormality in chronic pulmonary diseases: pulsed Doppler echocardiography study

Features of venous return in chronic pulmonary diseases and factors determining such features were studied by analysis of respiration-related variation in the superior vena cava flow on pulsed Doppler echocardiography. Subjects of this study were 85 patients with chronic pulmonary diseases; 54 healthy subjects served as normal controls. In the healthy subjects, the velocity of the S and D waves increased during inspiration (type I pattern), and the velocity of the A wave increased during expiration. In the patients with pulmonary diseases, the pattern of the superior vena cava flow was either type I or type II (disappearance of the D wave or disappearance of both the D and S waves). The incidence of the type II pattern was significantly higher in the patients showing a reduction of both FEV1.0% and % VC. The respiration-related variation in the superior vena cava flow pattern was found to be determined by the pressure fall between right atrium and subclavian vein. A type II pattern was attributed to the elevation of right atrial pressure caused by positive pleural pressure. The velocity of the A wave increased during expiration, showing a good correlation with pulmonary vascular resistance. Venous return in the presence of chronic pulmonary disease was found to be affected by the type of ventilatory disturbance and intensity of pulmonary vascular resistance.

[Contrast echocardiographic detection of pulmonary arteriovenous shunt in a hypoxemic patient with liver cirrhosis]

A 62-year-old man with liver cirrhosis and hypoxemia was admitted to evaluate the etiology of hypoxemia. The patient had noticed exertional dyspnea for three years. Physical examination, laboratory tests, ultrasonography and liver scintigraphy revealed liver cirrhosis. The arterial blood gas test showed hypoxemia (PO2 46.3 mmHg). Chest roentgenogram showed old pulmonary tuberculosis and the pulmonary function test demonstrated decreased FEV 1.0% and %DLco, which did not account for the marked hypoxemia. Contrast echocardiography was performed by injecting hand-agitated saline into the antecubital vein. Three seconds after the right ventricle was opacified, the contrast echoes appeared in the left atrium and then the left ventricle. Pulmonary arteriography revealed no pulmonary arteriovenous fistula. Hemodynamic data showed low pulmonary vascular resistance. Contrast echocardiography by injecting hand-agitated saline from the catheter tip was performed at both pulmonary arteries and the left atrium was opacified by each injection. The hypoxemia was mainly attributed to a intrapulmonary arteriovenous shunt. Although the etiology of hypoxemia in liver cirrhosis seems to be multifactorial, the intrapulmonary arteriovenous shunt is the most important factor. Contrast echocardiography was useful for detecting this shunt.

Radiation therapy of adult T-cell leukemia

Between January, 1983 and December, 1991, 30 adult patients with T-cell leukemia (ATL) and lymph node or skin lesions resistant to chemotherapy were treated by irradiation. Thirty Gy of high energy x-rays, 60Co gamma rays or electrons was delivered to 22 lymph node lesions in 17 patients, for focal cutaneous lesions in 6 patients, and as total skin irradiation in 7 patients. Irradiation therapy was effective in all patients with skin lesions and in 12 of 17 patients with lymph node lesions. Symptoms such as pain or itching diminished in all cases and no severe side effects were observed. Radiation therapy thus achieved good control of ATL associated focal lesions resistant to chemotherapy. Even if the prognosis of ATL is poor, radiation therapy should be considered as a palliative therapy.

Relationship between plasma triglycerides and apolipoprotein CII in infants during the first year of life

Plasma triglyceride and apolipoprotein CII (apo CII) levels were measured in normal full-term infants and low-birth-weight infants at birth (from umbilical cord blood at 0 weeks), as well as at 2, 3, 4, 8, 24, and 48 weeks of age, and the relationship between plasma triglyceride and apo CII levels was studied. In both full-term and low-birth-weight infants, the plasma triglyceride and apoprotein CII levels were very low at birth, but they increased rapidly thereafter in the full-term infants and somewhat more slowly in the low-birth-weight infants. Both triglyceride and apoprotein CII levels became stable from 3 weeks of age in full-term infants and from 8 weeks in low-birth-weight infants. When the logarithmic values of triglyceride and apoprotein CII levels were compared, they showed a close correlation, and slopes of regression lines were 0.62 in full-term infants aged 0-2 weeks, 1.04 in full-term infants aged 3-48 weeks, 0.56 in low-birth-weight infants aged 0-4 weeks, and 1.04 in low-birth-weight infants aged 8-48 weeks. These results suggest that there may be some differences in triglyceride transport between full-term infants aged 0-2 weeks and 3-48 weeks as well as between low-birth-weight infants aged 0-4 weeks and 8-48 weeks.

[An evaluation of a therapy with antibacterial and antifungal agents infections with hematological disorders]

The primary objective of this study is to confirm the efficacy and safety of combination therapy with antibacterial and antifungal drugs for patients with hematological disorders complicated with infections of unknown causative organisms. The subjects consisted of 55 patients with hematological disorders, 28 males and 27 females, ranging from 1 to 78 years of age, with an average age of 34 years. The breakdown of the patients by disease was: 41 leukemias, 10 malignant lymphomas, 3 myelodysplastic syndromes and an aplastic anemia. All patients were treated with sulbactam/cefoperazone (SBT/CPZ) and aminoglycoside (AG) plus fluconazole (FLCZ) as an empiric therapy. Overall efficacy rate was 54.5% for all the patients: 57.7% for patients with suspected sepsis and 0% for those with pneumonia from which unknown organisms were detected. The efficacy rate was 59.4% for patient who had been previously treated with other antibiotics and 47.8% for those who had not previously been treated. The above results suggested that this combination therapy might be effective for severe infections of unknown causative organisms associated with hematological disorders.

[Transcatheter hepatic arterial embolization for the treatment of blunt hepatic injury]

To examine the indications of transcatheter arterial embolization (TAE) for blunt hepatic injury, angiographic images, CT images and medical records were reviewed. Hepatic angiography was performed in 30 patients with blunt hepatic injury. Sixteen of them who underwent TAE therapy immediately after angiography formed the TAE(+)group, while the 14 patients who were not followed by TAE formed the TAE(-)group. Angiographic extravasation of the contrast medium was confirmed in 14 of 16 patients in the TAE(+)group. On CT scan, the most common finding in the TAE(+)group was a deep hepatic laceration, which was classified as type III according to the criteria of the Japanese association for the surgery of trauma. Hemoperitoneum and fresh hematoma were visualized in most of the TAE(+)group. The preoperative hemodynamics of the TAE(+)group were markedly unstable, but were significantly improved after TAE therapy. No major complications were encountered during or after TAE. These results suggested that TAE was an effective therapeutic procedure for the control of blunt hepatic injury in patients associated with unstable hemodynamics, deep hepatic laceration shown by CT scan and extravasation confirmed by angiography.

The roles of Ca2+/calmodulin- and cGMP-dependent pathways in gametogenesis of a rodent malaria parasite, Plasmodium berghei

The induction mechanism of gamete formation (gametogenesis) in a rodent malaria parasite, Plasmodium berghei, was investigated using Ca2+ antagonists, protein kinase inhibitors and amiloride, an inhibitor of monovalent cation/H+ exchange. Treatment with 3,4,5-trimethoxybenzoic acid 8-(diethylamino)octyl ester (TMB-8, a Ca2+ release inhibitor) and W-7/W-66 (calmodulin inhibitors) blocked formation of male gametes by inhibiting DNA synthesis from 1.5C to 8C level. In contrast, inhibitors of cAMP/cGMP-dependent protein kinases such as H-8, H-87, H-89 and staurosporine also ceased the development of gametocytes, but DNA synthesis in male gametocytes occurred as in the controls. Electron microscopy revealed that male gametocytes treated with TMB-8 and W-7 failed to enlarge nuclei and to form axonemes in the cytoplasm. In female gametocytes, treatment with both Ca2+ antagonists resulted in a dramatic morphological change in the endoplasmic reticulum (ER), which is thought to be a Ca2+ store. The ER network condensed near nuclei and was laminated by the abnormal attachment of ribosomes between two ER membranes. On the other hand, male gametocytes treated with protein kinase inhibitors or amiloride had enlarged nuclei and axonemes, but failed to develop further. The ER network in female gametocytes treated with these inhibitors was similar to that in the controls.

A case of neonatal calf with meningitis associated with Klebsiella oxytoca infection

A 16-days-old calf exhibited pyrexia, difficulty to stand and walk, cloudiness of the ocular aqueous humor, and swelling of the shoulder joints. The primary pathological lesion was fibrinopurulent meningitis with Gram-negative small bacilli, and which was concurrently accompanied with endophthalmitis, polyarthritis, and purulent inflammation in several visceral organs. Klebsiella oxytoca was isolated from the brain and spinal cord. These results suggest that this is a rare case of meningitis with septicemic K. oxytoca infection in neonatal calf.

[Surgical treatment of acute aortic dissection in the aged: a case report]

A 77-year-old woman with Stanford type A acute aortic dissecting aneurysm was successfully treated by the sutureless technique using arringed intraluminal graft. A month after the operation, re-dissection to the distal abdominal aorta occurred. Because of the poor condition of the patient and her great age, we chose an antihypertensive therapy instead of a reoperation. Two years after the operation this patient leads a sound life without any symptoms. In a case of acute aortic dissection of the aged, special consideration may be allowed to a surgical method and a decision-making for a reoperation.

Listeric septicemia with meningitis in a neonatal calf

A 9-days-old calf which had exhibited depression and difficulty to stand and walk was examined pathologically and bacteriologically. The primary pathological changes consisted of multifocal necrosis in several visceral organs and fibrinopurulent meningitis. The necrotic lesions were most frequently found in the liver, and accompanied with mononuclear cell infiltration and Gram-positive small bacilli. The organisms were also present in the foci of mononuclear cells at the central gray matter of the mesencephalon. Listeria monocytogenes was isolated from the brain and other organs of the whole body.

Cutaneous vascular anatomy of the thoracic region of the dorsum and its role in flap design in the rat

The cutaneous vascular anatomy of the proximal one-half of the dorsum (the thoracic region) and its role in flap design was studied in the rat. The investigation included anatomical dissection, ink injection into the axial artery, and flap harvesting in live animals. Anatomical dissection and india ink injection of the thoracic region revealed that the skin derives its principal blood supply from the lateral thoracic artery. The cutaneous vascular territory of the lateral thoracic artery was defined as follows: the medial border, along the midline of the back from the level of the inferior angle of the scapula to the lower border of the last rib; the lateral border, anterior axillary line corresponding with the length of the medial border; the cephalic border, a line joining the medial and lateral border at the level of the inferior angle of the scapula; and the caudal border, a line corresponding to the lower border of the last rib. Bilateral vascular pedicle island cutaneous flaps were harvested in living rats based on the vascular territory demarcated by India ink injection. All flaps survived; hence, this flap is reliable, with consistent vascularity, and is easy to harvest, and therefore, can be used as a vascular pedicle experimental model to study flap hemodynamics.